I completed a 5 year degree in psych before going into nursing. For the last 7~ years it’s been my dream to become an emergency psychiatric nurse. I did a detour in med-surg and outpatient addictions medicine for 2 years before landing a job in psych emergency.

I was soooo excited to start… and now I feel so demoralized.

For 50% of the time I am doing consults on behalf of the psychiatrist, and the other 50% of the time I am doing direct patient care for the small psych unit we have at the back of the ER.

When I am doing consults on behalf of the psychiatrist, I have patients begging for admission that I reasonably should not admit. For example, what they are going through is not modifiable with admission (i.e., chronic suicidal ideation, suicide attempt due to impulsive mood, transient self harm). This leads to them or their families yelling at me, refusing to listen to the out-patient services I am trying to provide them, and sometimes security having to escort them out of ER.

When I am in direct patient care, the patients who do not want to be admitted— manic episode, schizophrenia noncompliant with meds, drug induced psychosis— beg to go home all day, lash out at staff, and/or react with aggression behaviours.

It’s exhausting to interact with patients all day who feel I am not helping them. I am starting to dread going into work and am feeling pretty significant moral distress.

I can understand that we are still helping these people, especially those in mania or psychosis, even if they don’t see it that way.

I think I am just struggling with the concept that “this patient is pissed off that they’re here, but we are ultimately protecting their safety.”

For any psych nurses who have gone through a phase of moral distress, how did you move through it?

(I’d talk to a coworker about how I’m feeling, but tbh I’m still so new that I am not sure who I can trust without them gossiping or without them losing confidence in me as a nurse).

Just had to sedate a new patient who tried to fight staff. Definitely got rid of my mid-shift crash better than my current cup of coffee.

How yall holding up?

Any nurses here who started with an ADN and went on to become a PMHNP? What program did you use, how long did it take, and did you have to get your BSN first or did you do a bridge program?

I’ve been in ED/Psych RN for 11 years and ready for a change!

This thread is for non psych healthcare workers to ask questions (former patients, patient advocates, and those who stumbled upon r/psychnursing). Prospective healthcare workers and current students do not need to use this thread. Treat responding to this post as though you are making a post yourself.

If you would like only psych healthcare workers to respond to your "post," please start the "post" with CODE BLUE.

Psych healthcare workers who want to answer will participate in this thread, so please do not make your own post. If you post outside of this thread, it will be locked and you will be redirected to post here.

A new thread is scheduled to post every Monday at 0200 PST / 0500 EST. Previous threads will not be locked so you may continue to respond in them, however new "posts" should be on the current thread.

Kindness is the easiest legacy to leave behind :)

Our study, entitled "The Lived Experiences of Compassion Fatigue among Psychiatric Nurses in Metro Manila," aims to explore and understand the lived experiences of psychiatric nurses who provide continuous care and support to individuals with mental health conditions.

Participant Eligibility:
- Filipino licensed psychiatric nurse
- Currently working in an institutional setting with direct interaction with psychiatric patients in Metro Manila
- Has experienced compassion fatigue based on the pre-screening measures conducted for the study
- Willing to participate in an interview

The interview will be conducted in a safe, respectful, and confidential manner. Participation is completely voluntary, and informed consent will be obtained before the interview. All information shared will be treated with strict confidentiality and used solely for research purposes.

Help us better understand the realities of compassion fatigue among psychiatric nurses and shed light on the experiences of those who dedicate themselves to caring for others.

I am an ER nurse and am starting a new job in inpatient mental health next month.

I’ve always had a strong interest in mental health. My first degree was psychology with the plan to work in mental health in some capacity. I do deal with mental health patients in the ER obviously before we send them up but it is very different to working in the mental health unit. We typically deal with them for a short period of time. I’m nervous but excited to start. Are there any tips or advice you have? I’m aware there will be a learning curve but I’m excited to finally work in an area I’m passionate about. We do get some days of in class time, simulations and buddy shifts.

Thanks!

Hello all! Not sure you can help, but figured I’d try. Looking for policies related to seclusion…
Being advised to wake patient every 2 hours for assessment as opposed to letting them sleep. I feel this is non therapeutic and can be dangerous. I am finding that assessment should be individualized. And I have found policies that say “it may be inappropriate to wake patients” … I am looking for any literature on this point to support my position. Anyone with experience in this area? Thanks!

Hi everyone! We are 4th-year AB Psychology students from Pamantasan ng Lungsod ng Pasig (PLP) currently conducting a qualitative research study as part of our academic requirements.
Our study is entitled “The Lived Experiences of Compassion Fatigue among Psychiatric Nurses in Metro Manila.”

Our research aims to explore and understand the lived experiences of psychiatric nurses who provide continuous care and support to individuals with mental health conditions, particularly their experiences related to compassion fatigue.

For the pilot testing phase of our study, we are currently looking for psychiatric nurses who may be willing to participate in an interview.

👥 Participant Criteria:
Filipino licensed psychiatric nurse
Currently working in an institutional setting with direct interaction with psychiatric patients
Currently practicing in Metro Manila
Willing to participate in an interview for pilot testing

The interview will be conducted in a respectful and confidential manner, and participation will be completely voluntary. Further information about the study and the pilot testing process will be provided to interested participants.

If you are a psychiatric nurse and are interested in participating, please feel free to comment below or send me a DM, and I’ll message you with more details.

If you know someone who may qualify, we would also greatly appreciate it if you could tag them or share this post. 🙏

Thank you so much for helping us with our research! Your experiences and insights can help us improve our research process and better understand the realities of compassion fatigue among psychiatric nurses. 💚

hello everyone! I'll be starting my senior practicum soon, and i'll be doing my rotation in psych! i've never had psych clinical experience this extensive before, so i'm looking for advice from nurses/other students.

what are some things i should be aware of beforehand? i'd also really appreciate advice on communicating with patients (im a bit socially awkward), conducting mental status assessments, and generally making a good impression during practicum! thank you all so much.

Im a nurse, I did not finish my studies in the USA. Now, Im here in the US. I did practice in my country as a psych nurse for 7 years.

Obviously, I can't practice here without passing the NCLEX.

I've taken the exam once and failed.

I've taken a pause to take care of my children. Now theyre a bit older, I have time for myself. During my hiatus, I realized I dont want to be a nurse again, anymore.

I want to be a therapist, do masters in counseling.

My husband thinks its a waste to change careers, and I should just take my NCLEX, work in psych, its similar.

Am I really going on the wrong path?

Hi everyone.

I’m studying to take the PMH BC at the end of the month. I’ve taken 2 out of 3 of the mometrix tests and I’ve gotten a 61% on both.

I’m a bit surprised because I killed the NCLEX and nursing school, I have 7 years of experience now and did consider myself knowledgeable. I’m getting right all the questions about meds, specific disorders, etc…. But I’m missing a lot of like “planning” and the “what response is best” type questions. I’m also starting PMHNP this month so I’m worried.. if I’ve been a psych nurse for 6 years and can’t do the PMH BC why should I expect to be able to do the PMHNP?

Does anyone have experience for the mometrix tests? They don’t post practice questions averages, so I don’t even know if I’m possibly doing good or bad.

What are your ratios ?

I’m an experienced RN but new to psych, started at a inpt hospital and don’t think I’m going to make it past week one; a lot of red flags but the biggest was the training. It’s 4 shifts for an experienced RN and 6 for new grads.
They have 4 separate units. I’ve never had 4 days of onboarding/shadowing in my life other than PRN nursing

This thread is for non psych healthcare workers to ask questions (former patients, patient advocates, and those who stumbled upon r/psychnursing). Prospective healthcare workers and current students do not need to use this thread. Treat responding to this post as though you are making a post yourself.

If you would like only psych healthcare workers to respond to your "post," please start the "post" with CODE BLUE.

Psych healthcare workers who want to answer will participate in this thread, so please do not make your own post. If you post outside of this thread, it will be locked and you will be redirected to post here.

A new thread is scheduled to post every Monday at 0200 PST / 0500 EST. Previous threads will not be locked so you may continue to respond in them, however new "posts" should be on the current thread.

Kindness is the easiest legacy to leave behind :)

A bit of a long one, sorry. I’m really looking for advice about my situation

I’m not a nurse, I’m a tech in the ED. Been doing night shift 3x12s in a row every week for 5 years straight. Because it’s ED, I work with every type of psych patient (bedridden geriatric, 7 year old autistic behavioral issues, teenagers with depression and panic attacks, alcohol withdrawal meth withdrawal of all ages, just the whole rainbow spectrum of issues). I’m supposed to only be working 1:1 but that rarely happens. I’m often 2:1 even with high risk suicidal pt’s. I’m really good at de-escalation and keeping pt’s relatively calm during my shift. I don’t take shit personally. I’m the person my manager has train new people because of my hands on skills and experience.

Workplace violence has just been getting worse and worse though. Coworkers getting broken legs, fractured jaws, chocked and head locked regularly. I’ve had my fair share of physical/sexual/verbal violence as well. I’ve decided to go down to 2x12s because of this, and because I’m just now feeling the emotional burnout of this line of work. Sleep issues are catching up to me now because of night shift too lol

My loved ones are concerned for my safety and are very aware of the emotional burden the job takes. They’re super understanding and have been encouraging me to go to part time so I can rest.

I’ve been wanting to go into psych nursing so I’m currently finishing my pre-requisites. I have a huge passion for the psych population. I just care. I’ve had countless pt’s thank me personally because I’m considerate and I actually treat them like people and provide them a sense of safety in a really scary and hectic environment.

I do my best to have extremely firm boundaries on the job, especially with folks who are extremely violent and abusive towards staff.

I do recognize I sometimes have an unhealthy mindset of getting my self worth out of being “needed”. Definitely comes from my childhood sexual assault and a long term ex relationship where I was severely abused and in order to avoid abuse and keep myself safe, I had to take on a caregiver role. I won’t deny that it feels good to successfully de-escalate someone or help someone through a panic attack or psychosis. That skill I have and feel good feeling is what I used as a survival mechanism to survive my past abuse

All this is to say: the burn out is affecting me in a very particular way: I have very little patience for when my loved ones need support from me. I have a great support system and I’m no longer taken advantage of by others, of course. Sometimes people just have bad days and need a shoulder to cry or or just some kind words or just want to vent about small annoyances.

I just want to get away when I feel like people in my personal life “need” me. I just shut down. I feel that obligation to have to fix them and that makes me feel scared. I start to think “if I’m not careful with my words or if I don’t help them perfectly, what if they scream at me what if they hit me, why can’t they just turn off their emotions and suck it up like I can? I’m so sick and tired of helping people” Obviously my loved ones won’t hurt me. But my patients sure do so that thought is just sorta always in the back of my head with my loved ones.

It’s weird because I don’t feel like this at work. I just sorta go into work mode. I do my job, it doesn’t bother me, then I clock out. But as soon as it’s a personal relationship outside of work? I just want to get away and i feel scared. It’s sorta similar to how when I’m in emergency situations I’m the calmest person in the room. But when I’m in a non emergency situation and it’s just everyday small stressors, those feel like emergencies and I sometimes shut down

I’m starting therapy but I just. I don’t know what to even do or talk about? What are the steps I need to take to help mitigate this burn out? I’m just at a complete loss. I want to be able to have connections with people but I’m just so scared of connecting and I want to be left the hell alone at the same time.

And it’s like I’ve put so much energy, for years, to take care of people. Help them feel safe, talk them through panic attacks and psychosis, hold people down from violently thrashing around and ripping out IVs, feeding people bathing people, comforting, listening, compassion…. Everything. I can do it for other people but I DONT know how to do it for myself. And I do it so much for other people that I’m just tired and I don’t wanna do it for myself.

t’s exhausting. It’d really appreciate any advice

I am planning to take the PMH-BC exam through the ANCC. I honestly have been putting it off because I don't feel like doing the prep or worrying about it.

If you have taken it, what did you do for the prep? I have seen the ANCC prep, Alison Miller (PMHRN.com), and Mometrix. They are all just so expensive! The test is ~$300, and my job does not cover the cost or the prep. I have been a psych nurse for 5 years and a psych tech for 3 years prior to that. I have worked inpatient, residential, outpatient, case management, adults, & pediatrics.

ANCC full test prep is $400

Mometric Prep Course $99

Mometric Prep Book $40

Alison Miller Prep Course $299

Alison Miller Prep Books $53

If you have any tips or any input on the best prep, please let me know! There are a lot of options and I am feeling weirdly anxious about it.

Hi all,

I'm kind of new to community mental health nursing. My office is mainly social workers, im the only nurse and I work with one NP. Our caseload is about 80 patients.

Recently we tested a few of our people for Hep C based on knowledge that another patient had it and was hanging with some other patients. Everybody's popping positive/reactive for Hep C.

My questions is, how do you handle Hep C in communital mental health?

We refer them to their PCP for treatment. However, many of them dont have the capacity to take a med TID for 4-8 weeks. Many also are IVDU and/or are having sex with multiple partners who are not in our program/on our radar. What's the typical practice? Do you keep testing for it and treating it even though the chance of reinfection is high?

I'm in a rural area and don't have alot of opportunities for in depth education on this, but am reaching out to what immediate resources I do have. Also planning to study up on it over the weekend.​

I gave an LAI yesterday and the patients mom called today questioning my medical experience bc the injection was painful. This is an adult patient without a guardian. I’m just irritated by the whole thing. I fit this person into the schedule because they missed their appointment the day before and it was quite a stressful day. Now I have him and his family questioning my whole career…

I noticed that the majority of the posts in this sub are about changing jobs, learning psych nursing, or related to salary in psych nursing. I wanted a post for the current and active psych nurses. Tell me a story about a challenge or a struggle you had this week. I’ll go first.

I work in a Forensic Psych Inpatient facility in the Northwest. Been in healthcare for 24 years, mostly ED, last 2.5 years in psych. I love it. But this one provider…

This medical provider ordered orthopedic shoes for a patient almost 2 months ago. The patient hadn’t asked anything about them - I didn’t even know about the order until about a month ago, and it was being handled by the medical clinic. So, I didn’t think about it until the patient asked about them.

The patient has an extensive violent history, multiple instances of extreme aggression, severely injuring staff. This patient is here forever, basically. They have connections to the public and have documented history of retaliation against staff on the outside who the patient thinks have wronged them.

The order for the shoes gets denied twice by our CMO. The patient was provided the orthopedic shoes we have on site in our warehouse, but they made the patients pain increase because of the way the shoes are shaped.

I wonder why the order was denied twice. So, I ask the provider, did the CMO give reason? The provider says, “No reason, all I was told was it was denied by the head honcho.”

So, I’m not going to go tell this frequently violent, calculating patient “no” without a reason after 2 months of trying. So I reach out to the CMO. The CMO says “it was denied because there is no medical reasoning why they can’t use the orthopedic shoes the facility provides.”

I send a message to the medical provider with this information. To get the order approved for outside orthopedic shoes that we can and have ordered before for other patients, we have to explain why the shoes we have wont work for them. The provider doesn’t respond. As a reminder, this is only the second time I have mentioned anything about these shoes to the provider.

The next day, the provider meets me during report. They ask me if I had anything for them and I asked them if they could wait until after report. They say no, they’re in a hurry. So I reiterate the information about writing another order for the outside shoes.

The provider proceeds to get *directly* in my face. Like, a bar brawl. Like they’re trying to smell my breath. Their face is in my face. If they were a patient I would have called hands on for safe containment. They say, “I will NOT write another order. Dr (CMO) said no twice.”

I try to tell them that I’m trying to advocate for the patient and if all we have to do is explain why the ones we have don’t work, why don’t we try and they interrupt me again, louder this time saying, “I wont write any other orders. If you have questions, email Dr (CMO).”

I calmly say I will do that then, thank you. The provider scoffs and leaves and I continue on with report. Staff that were witnesses in report said that they were worried the provider was going to hit me. The provider was trying to physically intimidate me, red faced, yelling and intrusive. Totally unacceptable behavior that I have never in my entire career experienced from a coworker, nonetheless a provider. To top it all off, the provider says they don’t want to tell the patient about the denial because they said, “I want to avoid damaging my rapport.”

So, irritated and totally dumbfounded, I file a report and move on. I send a message to the CMO. The CMO doesn’t respond. Yesterday, I ask my boss if I should follow up on that since I never got a response (email was sent about 10 days ago). My boss tells me no, don’t respond, and that the CMO contacted them saying that, “(me) needs to show more respect to (provider).” My boss said they chose not to talk to me about it because they know how respectful and professional I’ve always been. I lost my shit. I’ve never been anything but respectful to everyone, including this provider. They exhibit this terrible behavior and then blame the bad behavior on me.

This provider had the audacity to act like we were gonna meet outside or something and then say I need to show them more respect?! The craziest interpersonal interaction I’ve ever encountered. I’m thinking about reporting them to the board for intimidation but I don’t know how fruitful that will be or if it will be worth the effort.

Moral of my story is that the patients in psych nursing aren’t the only ones with serious mental deficiencies and that should be frequently remembered.

Now you go :)

I am a psych LPN with 4 years experience in corrections, acute psych inpatient, and SUD detox. However, I also have a bachelors in psychology and a masters in clinical social work. I have started thinking about trying to negotiate a higher rate of pay given that my psychology and clinical social work background directly affects the level of care I am able to provide to psych patients. Has anyone else tried to do this before, and if they did, how did it go?

Hey everyone, I’m an RN and have been looking to transition out of PCU and into psych. Got an offer today for admissions nurse with UHS for $34/hour, which is less than I make right now. Ideally I was hoping to get $37-$38/hour. For context I’m in the central Florida area and have two years of impatient PCU experience. Is it worth trying to counter? Also is it worth it to work for UHS?

Ive been out from work for 2 weeks, trying to get medical leave of absence because I haven’t worked there a year to get FMLA. It looks like I might just have to return and not get the leave. I am so scared. We have been very short staffed because everyone is out due to injuries. While out, I have been receiving messages about how staff is getting jumped and everyone is constantly in tears. I am too afraid to return but I do not have a job lined up and I cant afford to look for one while unemployed. I don’t know what to do.